The present invention relates to an anal incontinence treatment apparatus and method. More specifically, the invention relates to an anal incontinence treatment apparatus and method for surgical application in the body of an anal incontinence patient for restricting the colon or rectum of a patient.
Anal incontinence is a widespread problem. Many different solutions to this problem have been tried. Several kinds of sphincter plastic surgery are used today to remedy anal incontinence. There is a prior manually operated sphincter system in an initial clinical trial phase with the hydraulic sphincter system connected to a reservoir placed in the scrotum. Disadvantage of this system is that hard fibrosis created around the reservoir over time may cause malfunction of pumping components. Thus, the created fibrosis will sooner or later become a hard fibrotic layer which may make it difficult to pump the reservoir. Yet a further disadvantage is that the use of hydraulic fluid always entails a risk of fluid leaking from the prosthetis. Furthermore, it is a rather complicated task to mechanically manually pump the reservoir when defaecation is needed . U.S. Pat. No. 5,593,443 discloses hydraulic anal sphincter under both reflex and voluntary control. An inflatable artificial sphincter with the pump system in scrotum is disclosed in U.S. Pat. No. 4,222,377.
A prime object of the present invention is to provide an anal incontinence treatment apparatus, which does not require manual manipulation of a combined reservoir a pump mechanism placed in the scrotum or labia majora region of the patient.
Another object of the invention is to provide an anal incontinence treatment apparatus, which does not require complicated surgery.
Yet another object of the invention is to provide an anal incontinence treatment apparatus, which may be conveniently remotely controlled by the patient.
Accordingly, the present invention provides an anal incontinence treatment apparatus, comprising an adjustable restriction device implanted in a patient, who suffers from anal incontinence, and engaging a portion of the colon or rectum of the patient to restrict the fecal passageway therein, an adjustment device which adjusts the restriction device to restrict the colon or rectum to close the fecal passageway, or release the colon or rectum to open the fecal passageway, and a powered hydraulic operation device for adjusting the adjustment device.
Preferably the hydraulic operation device adjusts the adjustment device in a non-manual manner. The expression xe2x80x9cnon-manually mannerxe2x80x9d should be understood to mean that the restriction device is not adjusted by manually touching subcutaneously implanted components of the apparatus or not manipulated by touching the skin of the patient. Preferably, the adjustment device adjusts the restriction device in a non-invasive manner. The expression powered should be understood as energised with everything without manual force, preferable electric energy.
The adjustment device may adjust the restriction device in a non-magnetic manner, i.e. magnetic forces may not be involved when adjusting the restriction device.
The adjustment device may also adjust the restriction device in a non-thermal manner, i.e. thermal energy may not be involved when adjusting the restriction device. Furthermore, as opposed to prior art anal incontinence treatment devices the adjustment device of the invention is not operated by manual forces, such as by manually compressing a fluid containing balloon implanted in the scrotum. Instead the apparatus of the invention may further comprise a powered operation device for operating the adjustment device.
In the various embodiments hereinafter described the restriction device generally forms an at least substantially closed loop. However, the restriction device may take a variety of different shapes, such as the shape of a square, rectangle or ellipse. The substantially closed loop could for example be totally flat, i.e. thin as seen in the radial direction. The shape of restriction device may also be changed during use, by rotation or movements of the restriction device in any direction.
Preferably the restriction device controls the size of the area of the fecal passageway in the colon or rectum, preferably to change steplessly with a preselected size that is satisfactory for the patient.
A control device for controlling the restriction device may conveniently be provided and may comprise an internal programmable control unit implanted in the patient and, possibly an external control unit outside the patient""s body for programming the programmable internal control unit. Alternatively, the external control unit may be programmable and wirelessly control the restriction device.
At least one sensor for sensing at least one physical parameter of the patient may conveniently be implanted in the patient. The sensor preferably senses the pressure against the restriction device or the colon or rectum or other important parameters and either the internal control unit or the external control unit of the control device may suitably control the restriction device to release the fecal passage way. For safety the restrictor device may release the fecal passageway in response to the sensor sensing for example an abnormally high pressure value. The internal control unit may directly controls the restriction device in response to signals by the sensor.
The apparatus preferably comprises a control device which may comprise both an internal or an external control unit for controlling the restriction device preferable for wirelessly controlling the restriction device. Preferable the implanted internal control unit being programmable by the external control unit. The external control unit may also be programmable.
Preferably, a hydraulic operation device, suitably electrically powered, is implanted in the patient for operating the adjustment device and a reservoir is also implanted in the patient and contains a predetermined amount of hydraulic fluid, wherein the hydraulic operation device operates the adjustment device by using the hydraulic fluid of the reservoir.
In accordance with a first main embodiment of the invention, the adjustment device comprises an expandable cavity in the restriction device, the colon or rectum being sqeezed upon expansion of the cavity and released upon contraction of the cavity, and the hydraulic operation device distributes hydraulic fluid from the reservoir to expand the cavity, and distributes hydraulic fluid from the cavity to the reservoir to contract the cavity.
A fluid distribution tube may readily be connected between the reservoir and the cavity in a manner so that the tube does not interfere with other implanted components of the apparatus.
Preferably, the reservoir defines a chamber for the predetermined amount of fluid and the hydraulic operation device changes the size of the chamber. The hydraulic operation device suitably comprises first and second wall portions of the reservoir, which are displaceable relative to each other to change the size of the chamber of the reservoir. The hydraulic operation device may distribute fluid from the reservoir to the cavity of the restriction member in response to a predetermined first displacement of the first wall portion of the reservoir relative to the second wall portion of the reservoir and may distribute fluid from the cavity to the reservoir in response to a predetermined second displacement of the first wall portion relative to the second wall portion.
The first and second wall portions of the reservoir may be displaceable relative to each other by manual manipulation, such as by manually pushing, pulling or rotating any of the wall portions in one direction, or alternatively, may be displaceable relative to each other by a device powered magnetically, hydraulically, or electrically (e.g. by an electric motor). In this embodiment no pump is used, only the volume of the reservoir is varied. This is of great advantage compared to the solution described below when a pump is used to pump fluid between the reservoir and the adjustment device because there is no need for a non-return valve and it is still possible to have fluid going both to and from the reservoir.
The operation device may comprise a fluid conduit, which is devoid of any non-return valve between the pump and the cavity (including the same) and the reservoir may form part of the conduit and a fluid chamber with a variable volume. The pump may distribute fluid from the chamber to the cavity by reduction of the volume of the chamber and withdraw fluid from the cavity by expansion of the volume of the chamber. The operation device preferably comprises a motor for driving the pump, which may comprise a movable wall of the reservoir for changing the volume of the chamber. Any kind of motor could be used for the different operations as well as wireless remote solutions.
In accordance with a particular embodiment of the invention, the hydraulic operation device comprises a pump for pumping fluid between the reservoir and the cavity of the restriction device. The pump preferably comprises a first activation member for activating the pump to pump fluid from the reservoir to the cavity of the restriction device, and a second activation member for activating the pump to pump fluid from the cavity to the reservoir. The first and second activation members may be operable by manual manipulation thereof, such as by manually pushing, pulling or rotating any of the activation members in one direction. At least one of the activation members is constructed to operate when subjected to an external pressure exceeding a predetermined magnitude.
As an alternative to the manual manipulation, at least one of the first and second activating members may be operable by a device powered magnetically, hydraulically, or electrically (e.g. by an electric motor). The pump may pump fluid both to and away from the adjustment device or hydraulic device controlling the adjustment device. A mechanical solution is proposed in which it is possible to pump in both directions just by pushing an activating member in one direction. Another alternative is a pump pumping in only one direction and an adjustable valve to change the direction of fluid to either increase or decrease the amount of fluid in the reservoir. This valve may be manipulated either manually, mechanically, magnetically, or hydraulically.
Wherever a magnetic means is utilized according to the invention it may comprise a permanent magnet and a magnetic material reed switch, or other suitable known or conventional magnetic devices.
A physical lumen, like the colon or rectum or the prolongation thereof, is often easier to restrict by contracting at least two opposite or different side walls of the lumen against each other. The expression xe2x80x9ccolon or rectum or the prolongation thereofxe2x80x9d should be understood to mean the rectum extended all the way out to the anal sphincter and following the passage of the large bowel in the other direction. It is also possible to use only one element and squeeze against human bone or tissue.
Either mechanical or hydraulic solutions may be employed to operate the restriction device. Alternatively, the restriction device may comprise an adjustable cuff, a clamp or a roller for bending the colon or rectum or the prolongation thereof to restrict the fecal passageway therein. Such a cuff, clamp or roller may also be utilized for squeezing the colon or rectum or the prolongation thereof against human material inside the body of the patient for an example the sacral bone of the patient.
Advantageously, the forming means may form the restriction member into a loop having a predetermined size.
The adjustment device may change the size of the restriction opening such that the outer circumferential confinement surface of the restriction member either is changed or is unchanged.
Preferable the restriction device comprises an elongated restriction member and forming means for forming the restriction member into at least a substantially closed loop around the colon or rectum or it""s prolongation, the loop defining a restriction opening, whereby the adjustment device adjusts the restriction member in the loop to change the size of the restriction opening.
The elongated restriction member may be flexible, for example take the shape of a belt or a cord, and the adjustment device may pull a first portion of the flexible restriction member from a second portion of the flexible restriction member opposite the first portion in the loop to squeeze the colon or rectum or the prolongation thereof between two opposite lengths of the elongated flexible restriction member to restrict the fecal passageway. The restriction member may be non-inflatable, and the adjustment device may mecanically adjust the restriction member in the loop.
In accordance with a particular embodiment of the invention, the adjustment device mechanically adjusts the restriction device. Thus, the restriction device may comprise two or more elements on different sides of the colon or rectum, and the adjustment device may squeeze the colon or rectum or the prolongation thereof between the elements to restrict the fecal passageway.
In accordance with an alternative, the restriction device may comprise two articulated clamping elements positioned on opposite sides of the colon or rectum or the prolongation thereof, and the adjustment device may move the clamping elements towards each other to clamp the rectum between the clamping elements to restrict the fecal passageway.
In accordance with another alternative, the restriction device may bend the colon or rectum or the prolongation thereof. For example, the restriction device may comprise at least two bending members, such as cylindrical or hour-glass shaped rollers, positioned on opposite sides of the colon or rectum or the prolongation thereof, and the adjustment device may move the bending members against the esophagus or stomach to bend the latter to decrease the the colon or rectum or the prolongation thereof in two opposite spaced apart directions to bend the colon or rectum or the prolongation thereof to restrict the fecal passageway. The bending or rotating members may have any shape or form and be either hydralic or non-inflatable.
In accordance with another particular embodiment of the invention, the hydraulic operation device comprises a servo means, suitably including hydraulic means. Alternatively, the servo means may include magnetic or electric means. Preferably, the servo means comprises a servo reservoir defining a chamber containing servo fluid and the hydraulic operation device comprises first and second wall portions of the servo reservoir, which are displaceable relative to each other to change the size of the chamber of the servo reservoir. The same principle will apply for the servo reservoir as for the earlier described reservoir wherein the volume in the servo reservoir may be increased or decreased by a first or second displacement of the first wall portion relative to the second wall portion of the servo reservoir and thereby control the earlier described reservoir and thereby indirectly control the fecal passageway. The first and second wall portions of the servo reservoir may be displaceable relative to each other by manual manipulation, such as by manually pushing, pulling or rotating any of the wall portions of the servo reservoir in one direction. Alternatively, the first and second wall portions may be displaceable by magnetically, hydraulically or electrically powered devices. These powered devices may all be activated by manual manipulating means preferably located subcutaneously. This activation may be indirect, for example via a switch.
Especially when manual manipulation means are used, the servo means is suitable to use. With servo means less force is needed for controlling the adjustment device. Hydraulic operation is preferably used with the servo means. One example is a closed system that controls another closed system in which hydraulic components of the adjusment device are incorporated. Minor changes in the amount of fluid in a reservoir of the first system could then lead to major changes in the amount of fluid in a reservoir in the second system. Consequently, the change in volume in the reservoir of the second system affects the hydraulic operation of the adjustment device which is incorporated in the second closed system. The great advantage of such a servo means is that the larger volume system could be placed at a suitable location, e.g. inside the abdomen where there is more space, and still it would be possible to use manual manipulation means of the smaller system subcutaneously. The servo reservoir could control the reservoir of the larger volume.
The servo reservoir could be controlled directly or indirectly by a small fluid supply reservoir, which may be placed subcutaneously and may be activated by manual manipulation means controlling the servo reservoir or other suitable device.
Preferably, the hydraulic operation device comprises first and second wall portions of the fluid supply reservoir, which are displaceable relative to each other to change the size of the chamber of the fluid supply reservoir. The hydraulic operation device may distribute fluid from the fluid supply reservoir to the servo reservoir in response to a predetermined first displacement of the first wall portion of the fluid supply reservoir relative to the second wall portion of the fluid supply reservoir and to distribute fluid from the servo reservoir to the fluid supply reservoir in response to a predetermined second displacement of the first wall portion relative to the second wall portion. The wall portions of the fluid supply reservoir may be displaceable relative to each other by manual manipulation means or be displaceable relative to each other by manual manipulation means for pushing, pulling, or rotating any of the wall portions of the fluid supply reservoir in one direction. Alternatively, the wall portions of the fluid supply reservoir may be displaceable relative to each other by magnetic means, hydraulic means, manually manipulated means, or electrical control means including an electric motor. The magnetic means, hydraulic means, or electrical control means may all be activated by manually manipulated means preferably located subcutaneously. This control may be indirect, for example via a switch.
Even in the broadest embodiment of the invention the adjustment device may comprise a servo means. The servo means may comprise a hydraulic means, an electric control means, a magnetic means, mechanical means, or a manual manipulating means. The hydraulic means, electric control means, mechanical means or magnetic means may be activated by manual manipulating means. Using a servo system will save the use of force when adjusting the adjustment device which may be of importance in many applications.
All systems according to the invention may be controlled by a wireless remote control.
In accordance with an advantageous embodiment of the invention, there is provided a wireless remote control for controlling the restriction device. The remote control may conveniently comprise an external hand-held remote control unit which is manually operable by the patient to control the restriction device to squeeze and release the colon or rectum or the prolongation thereof. The remote control may advantageously be capable of obtaining information on pressure or other important parameters such as the pressure against the restriction device and of commanding the operation device to operate the adjustment device to adjust the restriction device in response to obtained information. With the remote control the apparatus of the invention is conveniently controlled to adjust the implanted restriction device, which controls the restriction of the fecal passageway and wherein the restriction device is operable to open and close the fecal passageway. With the remote control the restriction device may steplessly controls the cross-sectional area of the passageway.
The apparatus of the invention may further comprise a pressure sensor for directly or indirectly sensing the pressure against the restriction device and the control device may control the restriction device in response to signals from the pressure sensor. The adjustment device preferably non-invasively adjusts the restriction device to change the size of the cross-sectional area.
The adjustment device or other energy consuming components of the apparatus may also be energised with wirelessly transmitted energy from outside the patient""s body or with with an implanted battery or accumulator.
The apparatus may further comprise an implanted energy transfer device, wherein the control device releases electric energy and the energy transfer device transfers the electric energy directly or indirectly into kinetic energy for operation of the restriction device.
The remote control comprises means for wireless transfer of energy from outside the patient""s body to energy consuming implanted components of the apparatus. A motor may suitably be implanted for operating the operation device and the means for wireless transfer of energy may directly power the motor with transferred energy. The energy transferred by the means for transfer of energy may comprise a wave signal, an electric field or a magnetic field. Preferably, the wireless remote control comprises an external signal transmitter and an implanted signal receiver. For example, the signal transmitter and signal receiver may transmit and receive a signal in the form of digital pulses, which may comprise a magnetic or electric field. Alternatively, which is preferred, the signal transmitter and signal receiver may transmit and receive a wave signal, which may comprise an electromagnetic wave signal, a sound wave signal or a carrier wave signal for a remote control signal. The receiver may comprise a control unit for controlling the hydraulic operation device in response to signals from the signal transmitter.
The apparatus of the invention may further comprise an implanted energizer unit for providing energy to implanted energy consuming components of the apparatus, such as electronic circuits and/or a motor for operating the operation device. The control unit may power such an implanted motor with energy provided by the energizer unit in response to a control signal received from the signal transmitter. Any known or conventional signal transmitting or signal receiving device that is suitable for use with a human or mammal patient may be provided as the signal transmitter or signal receiver. The control signal may comprise an electromagnetic wave signal, such as an infrared light signal, a visible light signal, a laser light signal, a microwave signal, or a sound wave signal, such as an ultrasonic wave signal or an infrasonic wave signal, or any other type of wave signals. The control signal may also comprise electric or magnetic fields, or pulses. All of the above-mentioned signals may comprise digital signals. The control signals may be carried by a carrier signal, which may be the same as the wireless energy signal. Preferably, a digital control signal may be carried by an electromagnetic wave signal. The carrier signal or control signal may be amplitude or frequency modulated.
The motor may be any type of motor, such as a pneumatic, hydraulic or electric motor and the energizer unit may power the motor with pressurized gas or liquid, or electric energy, depending on the type of motor. Where the motor is an electric motor, it may power pneumatic or hydraulic equipment. In all embodiments a motor may be operatively connected to the adjustment device and the control of the motor may be effected by a reversing device implanted in the patient for reversing the function performed by the motor. The reversing device implanted in the patient may also reverse the function performed by the restriction device.
The adjustment device preferably in all embodiments adjusts the restriction device in a non-manual manner without touching the skin of the patient.
The energizer unit may comprise a power supply and the control unit may power the motor with energy from the power supply. Preferably, the power supply is an electric power supply, such as a battery, and the motor is an electric motor. In this case, the battery also continuously powers the circuitry of the signal receiver between the adjustment operations, in order to keep the signal receiver prepared for receiving signals transmitted from the signal transmitter.
The energizer unit may transfer energy from the control signal, as the latter is transmitted to the signal receiver, into electric energy for powering the implanted electronic components. For example, the energizer unit may transfer the energy from the control signal into direct or alternating current.
In case there is an implanted electric motor for operating the operation device the energizer unit may also power the motor with the transferred energy. Advantageously, the control unit directly powers the electric motor with electric energy, as the energizer unit transfers the signal energy into the electric energy. This embodiment is particularly simple and does not require any recurrent invasive measures for exchanging empty power supplies, such as batteries, that is required in the first embodiment described above.
For adjustment devices of the type that requires more, but still relatively low, power for its operation, the energizer unit may comprise a rechargeable electric power supply for storing the electric energy obtained and the control unit may power the electric motor with energy from the rechargeable electric power supply in response to a control signal received from the signal transmitter. In this case, the rechargeable power supply can be charged over a relatively long time (e.g. a few seconds up to a half hour) without powering the electric motor.
The electric power supply suitably comprises an inexpensive simple capacitor. In this case, the electric motor may be a stepping motor.
The signal transmitter may transmit an electromagnetic signal and the energizer unit may draw radiant energy from the electromagnetic wave signal, as the latter is transmitted to the signal receiver, and transfer the radiant energy into electric energy.
Alternatively, the energizer unit may comprise a battery, an electrically operable switch adapted to connect the battery to the signal receiver in an on mode when the switch is powered and to keep the battery disconnected from the signal receiver in a standby mode when the switch is unpowered, and a rechargeable electric power supply for powering the switch. The control unit may power the electric motor with energy from the battery in response to a control signal received from the signal transmitter, when the switch is in its on mode. Advantageously, the energizer unit may transfer wave energy from the control signal, as the latter is transmitted to the signal receiver, into a current for charging the rechargeable electric power supply, which suitably is a capacitor. Energy from the power supply is then used to change the switch from off (standby mode) to on. This embodiment is suited for adjustment devices of the type that require relatively high power for their operation and has the advantage that the electronic circuitry of the signal receiver does not have to be powered by the battery between adjustments. As a result, the life-time of the battery can be significantly prolonged. The switch may be switched with magnetic, manual or electric energy. Preferable the switch is controlled by wireless energy.
As an example, the signal transmitter may transmit an electromagnetic wave signal and the energizer unit may draw radiant energy from the electromagnetic wave signal, as the latter is transmitted to the signal receiver, and may transfer the radiant energy into the current. The energizer unit suitably comprises a coil of the signal receiver for inducing an alternating current as the electromagnetic wave signal is transmitted through the coil and a rectifier for rectifying the alternating current. The rectified current is used for charging the rechargeable power source.
Alternatively, the signal transmitter and receiver may solely be used for a control signal and a further pair of signal transmitter and receiver may be provided for transferring signal energy to implanted components. By such a double system of signal transmitters and receivers the advantage is obtained that the two systems can be designed optimally for their respective purposes, namely to transmit a control signal and to transfer energy from an energy signal. Accordingly, the apparatus may further comprise an external energy transmitter for transmitting wireless energy, wherein the energizer unit comprises a battery and an operable switch for connecting the battery to the signal receiver in an on mode when the switch is powered and for keeping the battery disconnected from the signal receiver in a standby mode when the switch is unpowered, and the external energy transmitter powers the switch. Suitably, the energy transmitter may directly power the switch with the wireless energy to switch into the on mode.
As should be realized by a skilled person, in many of the above-described embodiments of the invention the adjustment device may be operated by control means or manual manipulation means implanted under the skin of the patient, such as a pump, an electrical switch or a mechanical movement transferring means. In the manual embodiment it is not necessary to use a motor for operating the adjustment device.
In accordance with an alternative aspect of the present invention a hydraulic adjustment device adjusts the restriction device to temporarily squeeze the colon or rectum or the prolongation thereof by means of more than one restriction members to restrict the fecal passageway.
In accordance with a further alternative aspect of the present invention it provides an anal incontinence treatment apparatus, comprising an adjustable restriction device implanted in a patient, who suffers from anal incontinence, the restriction device having two restriction members engaging the colon or rectum or the prolongation thereof of the patient to engage the fecal passageway. An adjustment device adjusts the restriction device to temporarily release the colon or rectum or the prolongation thereof and normally to restrict the fecal passageway, and preferable an electrically powered operation device operates the adjustment device in a non-manual manner.
In accordance with another alternative aspect of the present invention there is provided two holding members, one placed more distal than the other, comprising two at least substantially closed loops may be rotated in opposite direction to each other. With interconnecting material for example flexible bands between the holding members a restriction will occure between the holding members when they are rotated.
The restriction device may in all applicable embodiments have any shape or form and be either hydralic or non-inflatable.
Preferably the adjustment device may be engergised directly with wirelessly transmitted energy from outside the patient""s body. Preferable, the inplanted energy transfer device transfers wireless energy directly or indirectly into kinetic energy for operation of the restriction device. In another embodiment it would also be possible to use an implanted accumulator or battery and control this implanted energy source from outside the patient""s body to supply energy to the adjustment device or other energy consuming parts of the implanted apparatus.
It should be understood that all the applicable embodiments in this application may be combined to achieve alternative embodiments of the invention.
The above described embodiments according to the general aspect of the invention may also be implemented in the described embodiments according to the alternative aspects of the invention, where applicable.
The invention also provides a method for treating a patient suffering from anal incontinence comprising surgically implanting in the body of the an adjustable restriction device which directly engages the colon or rectum to restrict the fecal passageway therein, normally closed, and when desired, mechanically adjusting the restriction device to temporarily open the fecal passageway.
The adjustable restriction device may preferably be inplanted in the base or prolongation of the patients rectum. It is possible to use one or serveral restricting devices engaging the colon or rectum.
In accordance with the invention, there is further provided a method for treating anal incontinence, comprising the steps of placing at least two laparascopical trocars in the body of a patient suffering from anal incontinence, inserting a dissecting tool through the trocars and dissecting an area of the colon or rectum in the abdominal or pelvic or retroperitoneal surroundings, placing at least one adjustable restriction device in the dissected area engaging the rectum or colon, adjusting the restriction device to normally restrict the fecal passageway in the rectum or colon, and adjusting the restriction device to open the fecal passageway when the patient wants to relieve himself or herself. A hydraulic adjustable restriction device may be used when practicing this method, preferably in a non-manual manner, i.e. without touching subcutaneously implanted components of the apparatus.
The method may further comprise implanting a source of energy in the patient and providing a control device for controlling the source of energy from outside the patient""s body to supply energy to the restriction device.
The present invention also provides a method for treating anal incontinence, comprising surgically implanting in the body of a patient suffering from anal incontinence an adjustable restriction device engaging the colon or rectum or the prolongation thereof to engage the fecal passageway, and when desired to achieve defaecation, adjusting the restriction device to temporarily release the colon or rectum or the prolongation thereof to open the fecal passageway. The method may further comprise implanting an elongated restriction member of the restriction device around the colon or rectum or the prolongation thereof. In all applications the operation device may be electrically powered.
A further method for treating anal incontinence, comprises surgically implanting in the body of a patient suffering from anal incontinence at least one adjustable restriction devices to affect the fecal passageway engaging respective of the colon or rectum or the prolongation thereof, and when desired to achieve defaecation, non-manually without touching the skin of the patient adjusting the powered restriction device to temporarily release the colon or rectum or the prolongation thereof to open the fecal passageway.
The anal incontinence treatment apparatus may also be laparoscopicily implanted. Thus, in accordance with the invention there is also provided a method comprising placing at least two laparascopical trocars in the body of a patient suffering from anal incontinence, inserting a dissecting tool through the trocars, dissecting an area of the pelvic or abdominal or retroperitoneal surroundings, and placing an adjustable restriction device in the dissected area in engagement with the colon, rectum or the prolongation thereof to restrict the fecal passageway.
The adjustment device may perferable be powered preferable with electricity and operated in a non-manual manner without touching the patients skin.